中耳胆固醇肉芽肿手术治疗效果分析

Analysis of surgical effect on middle ear cholesterol granuloma

目的:探讨中耳胆固醇肉芽肿(CG)手术方式的选择,并评估其治疗效果。方法:对手术治疗的66例中耳CG患者进行回顾性研究。根据病史、耳内镜、纯音听阈和颞骨CT确定手术方式。单纯鼓膜置管术12例,完壁式乳突切开+鼓室成形+鼓膜置管术40例,开放式乳突切开+鼓室成形+鼓膜置管术14例。检测手术前后纯音听阈的变化,并比较分析500、1000、2000、4000Hz这4个频率的平均气骨导差(ABG)。结果:1例单纯鼓膜置管术后出现通气管堵塞,另1例单纯鼓膜置管术后CG复发;1例完壁式乳突切开术取出通气管后出现分泌性中耳炎。单纯鼓膜置管术组手术前后ABG分别为(21.25±5.96)dB和(8.85±6.49)dB,完壁式乳突切开+鼓室成形+鼓膜置管术组分别为(34.19±10.43)dB和(23.55±12.48)dB,开放式乳突切开+鼓室成形+鼓膜置管术组分别为(36.43±12.11)dB和(25.71±13.50)dB,3组术后平均ABG较术前均有显著改善(P<0.01)。结论:中耳CG的手术治疗应遵循彻底清除病变、解除阻塞、通畅引流的原则,结合患者病情采用个性化的手术方式,术后应坚持长期随访。

Objective:To evaluate surgical effects on middle ear cholesterol granuloma(CG).Method:The patients receiving surgery due to middle ear CG were retrospectively analyzed.The choice of operative methods was made according to medical history,endotoscope,pure-tone audiometry and temporal bone CT.Tympanostomy tube(TT)insertion was performed on 12patients;canal wall up(CWU)tympanoplasty combined with tympanostomy tube was performed on 40patients,and canal wall down(CWD)tympanoplasty combined with TT on 14cases.The pre-and postoperative audiometric results(500,1000,2000and 4000Hz)were evaluated for each patient.Then the average air-bone gap(ABG)was analyzed.Result:One patient had postoperative tube obstruction.One patient who performed only TT insertion recurred.Secretory otitis media occurred in one case undergoing CWU tympanoplasty after removal of the ventilation tube.For TT insertion group,pre-and postoperative ABG levels were(21.25±5.96)dB and(8.85±6.49)dB,respectively(P<0.01).For CWU+TT group,pre-and postoperative ABG levels were(34.19±10.43)dB and(23.55±12.48)dB,respectively(P<0.01).For CWD+TT group,pre-and postoperative ABG levels were(36.43±12.11)dB and(25.71±13.50)dB,respectively(P<0.01).Conclusion:The aim of surgical treatment for middle ear CG includes thorough removal of lesions,im-provement of ventilation and drainage of middle ear.Individualized surgical strategy should be adopted according to the patients'conditions.And long-term follow-up should be done after operation.